Maxillary Central Incisor Implants: Solve Esthetic Problems?

I inherited this case from another dentist who placed and restored the two maxillary central incisors. Implants were placed 8/30/17 and are 3.3x13mm.  They are 1mm sub-crestal and were placed using a surgical guide. Basically when the doctor placed the cement retained crowns he told the patient that the gingiva would mature and fill in over the next year (That was in 12/20/17).

I last saw the patient in April of 2018. Patient is very concerned about the black triangles between 11 and 21 implants.

I am just wondering what is the best way to proceed? I cannot change where the implants were placed. But I could try doing a connective tissue graft or adding pink porcelain to the crowns but I feel that would be a really unaesthetic way to solve the problem. Thoughts?

6 thoughts on “Maxillary Central Incisor Implants: Solve Esthetic Problems?

  1. Leatha J Wood says:

    I’d like to see photographs of the actual crowns and black triangles.

    My first thought would be to place fillers into the papilla to work on minimizing the black triangles.

  2. DrAZ says:

    Tough to recommend anything without photographs. Depending on lip line, I would consider connecting implants on 8-9 with crowns/ pink porcelain. Your fighting an uphill battle and what looks good now will turn on you a few months down the road.

  3. Matt Helm DDS says:

    I agree with all the above posters that without photographs no true opinion can be formed. I, too, would like to actually see the black triangles between 11 and 21 that you describe. I am assuming that they are formed on either side by the incisal papilla and the implants, meaning the incisal papilla between 11 and 21 is incompletely formed. Interdental papillae can be somewhat modeled with the interproximal contours (the emergence profile) of the temp crowns in some cases. Not sure that this is the case, but worth noting. In principle I am not for pink porcelain since it never renders a natural look, especially in this very demanding area. Please upload some photos, with the lip retracted and with the patient’s natural smile line.

  4. Dr R Y says:

    Same here, I would like to see black triangle area in photographs with clear vision and if you have panoramic view as well.

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